|
047B3DZ
|
Facility
|
IP
|
$3,913.00
|
|
| Hospital Charge Code |
4273
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
047B3EZ
|
Facility
|
IP
|
$3,913.00
|
|
| Hospital Charge Code |
4274
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
047B3FZ
|
Facility
|
IP
|
$3,913.00
|
|
| Hospital Charge Code |
4275
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
047B3GZ
|
Facility
|
IP
|
$3,913.00
|
|
| Hospital Charge Code |
4276
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
047B441
|
Facility
|
IP
|
$8,623.00
|
|
| Hospital Charge Code |
2117
|
| Min. Negotiated Rate |
$8,623.00 |
| Max. Negotiated Rate |
$8,623.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
|
|
047B44Z
|
Facility
|
IP
|
$8,623.00
|
|
| Hospital Charge Code |
2118
|
| Min. Negotiated Rate |
$8,623.00 |
| Max. Negotiated Rate |
$8,623.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
|
|
047B45Z
|
Facility
|
IP
|
$8,623.00
|
|
| Hospital Charge Code |
2119
|
| Min. Negotiated Rate |
$8,623.00 |
| Max. Negotiated Rate |
$8,623.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
|
|
047B46Z
|
Facility
|
IP
|
$8,623.00
|
|
| Hospital Charge Code |
2120
|
| Min. Negotiated Rate |
$8,623.00 |
| Max. Negotiated Rate |
$8,623.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
|
|
047B47Z
|
Facility
|
IP
|
$8,623.00
|
|
| Hospital Charge Code |
2121
|
| Min. Negotiated Rate |
$8,623.00 |
| Max. Negotiated Rate |
$8,623.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
|
|
047B4D1
|
Facility
|
IP
|
$3,913.00
|
|
| Hospital Charge Code |
4277
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
047B4D6
|
Facility
|
IP
|
$3,913.00
|
|
| Hospital Charge Code |
4278
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
047B4DZ
|
Facility
|
IP
|
$3,913.00
|
|
| Hospital Charge Code |
4279
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
047B4EZ
|
Facility
|
IP
|
$3,913.00
|
|
| Hospital Charge Code |
4280
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
047B4FZ
|
Facility
|
IP
|
$3,913.00
|
|
| Hospital Charge Code |
4281
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
047B4GZ
|
Facility
|
IP
|
$3,913.00
|
|
| Hospital Charge Code |
4282
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
047C041
|
Facility
|
IP
|
$8,623.00
|
|
| Hospital Charge Code |
2122
|
| Min. Negotiated Rate |
$8,623.00 |
| Max. Negotiated Rate |
$8,623.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
|
|
047C04Z
|
Facility
|
IP
|
$8,623.00
|
|
| Hospital Charge Code |
2123
|
| Min. Negotiated Rate |
$8,623.00 |
| Max. Negotiated Rate |
$8,623.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
|
|
047C05Z
|
Facility
|
IP
|
$8,623.00
|
|
| Hospital Charge Code |
2124
|
| Min. Negotiated Rate |
$8,623.00 |
| Max. Negotiated Rate |
$8,623.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
|
|
047C06Z
|
Facility
|
IP
|
$8,623.00
|
|
| Hospital Charge Code |
2125
|
| Min. Negotiated Rate |
$8,623.00 |
| Max. Negotiated Rate |
$8,623.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
|
|
047C07Z
|
Facility
|
IP
|
$8,623.00
|
|
| Hospital Charge Code |
2126
|
| Min. Negotiated Rate |
$8,623.00 |
| Max. Negotiated Rate |
$8,623.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
|
|
047C0D1
|
Facility
|
IP
|
$3,913.00
|
|
| Hospital Charge Code |
4283
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
047C0D6
|
Facility
|
IP
|
$3,913.00
|
|
| Hospital Charge Code |
4284
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
047C0DZ
|
Facility
|
IP
|
$3,913.00
|
|
| Hospital Charge Code |
4285
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
047C0EZ
|
Facility
|
IP
|
$3,913.00
|
|
| Hospital Charge Code |
4286
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
047C0FZ
|
Facility
|
IP
|
$3,913.00
|
|
| Hospital Charge Code |
4287
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
